Triple anticoagulant therapy is necessary in patients who are at increased risk for both arterial (in stent) and venous thrombosis, or have atrial fibrillation. Triple therapy however also poses a very high risk for bleeding events, particularly because this subset of patients is particularly frail due to the high incidence of comorbidities and advanced age. Very little randomized studies have tested the impact of the many possible combinations of anticoagulant/antiaggregant drugs, and surveys among practicing physicians show that the use of off-label therapies is very common. In a recent survey from our group, we observed that physicians are very divided in terms of what therapy should be recommended to patients with indication to anticoagulation and with a history of stenting. The use of novel anticoagulants was as frequent as that of vitamin K antagonists, and the duration of triple therapy was very variable.While these data probably show that decisions are usually taken on an individual basis, considering the patient's risk of ischemia and hemorrhagic events, much of this variability probably depends on the fact that, failing randomized trials, guidelines in this area are relatively less specific than in other ones.
Keywords: Antiplatelet therapy; anticoagulants; coronary stenting.